Narrowband ultraviolet-B (NB-UVB) phototherapy is the mainstay of vitiligo therapy. The response can be evaluated using the vitiligo area scoring index (VASI) and repigmentation grade. However, few studies used VASI to evaluate phototherapy response and there are no definitive data on the reduction of VASI. This retrospective descriptive study aimed to determine the characteristics and decrease of VASI in patients with vitiligo after 36 and 48 sessions of NB-UVB phototherapy, conducted at Dr. Sardjito General Hospital, Yogyakarta, from December 2021-June 2022. The most common predilection was on the face (71.43%) and acral (61.90%). The most common responses after 36 and 48 phototherapy sessions were minimally improved (decrease in VASI<10%) and improved (reduction in VASI 10-25%). The mean decrease in VASI was 18% and 22% after 36 and 48 phototherapy sessions, respectively. 9.52% and 6.67% of patients experienced a reduction in VASI >50% after 36 and 48 phototherapy sessions, respectively. VASI assessment can be used to evaluate the response to phototherapy in vitiligo. However, VASI cannot show a reduction in vitiligo with slight repigmentation in slow-response patients.

Acute generalized pustular psoriasis (GPP) is a severe but rare variant of psoriasis, characterized by an acute eruption of extensive erythema with numerous non-follicular pustules. In rare cases, local pustular psoriasis like acrodermatitis continua of Hallopeau (ACH) may progress into acute GPP if improperly treated. ACH and GPP are rare in the clinic and their treatment is more complex and often treatment-resistant compared to psoriasis vulgaris (PV). A variety of anti-psoriasis biologics emerging in recent years have been reported for the treatment of ACH and acute GPP. Biologics is considered to be an upgraded treatment option for traditional anti-psoriasis agents. But there are few reports of GPP patients developing resistance to biologics, or what if biologics fails. Herein, we report a case of acute GPP that developed from ACH, initially responded extremely well to adalimumab, but the treatment failed when the patient treated with the drug again, which is thought to have developed resistance to adalimumab, finally successfully treated with narrowband ultraviolet B (NB-UVB) and acitretin.

Narrowband ultraviolet B (NB-UVB) (311-312 nm) is widely used for dermatological conditions with a favorable side-effect profile during pregnancy. Recently published data showed that NB-UVB might decrease serum folate level in Fitzpatrick skin phenotype I-III, especially at higher doses; this may predispose newborns to neural tube defects.
UNASSIGNED: To compare serum folate levels of skin of color females treated with NB-UVB and healthy females of childbearing age, as well as to note whether subsequent complications have been observed, if any.
UNASSIGNED: Multicenter, cross-sectional study of 30 females (N = 30): 15 female patients undergoing NB-UVB phototherapy as well as 15 age-, gender-, and skin phenotype-matched healthy volunteers who were enrolled into the study after excluding factors known to alter serum folate concentration. NB-UVB exposures were performed 2-3 times a week for at least 8-12 weeks (mean cumulative NB-UVB dose ± standard deviation [SD] was 55 ± 79 J/cm2).
UNASSIGNED: Mean serum folate ± SD in NB-UVB exposed and healthy controls were 10.3 ± 4 and 8.3 ± 3 ng/mL, respectively. This was not a statistically significant difference between the 2 groups (P = .14).
UNASSIGNED: Small sample size (N = 30) and a cross-sectional study type.
UNASSIGNED: Cumulative NB-UVB exposure is not associated with a statistically significant difference in serum folate level (P > .05) in skin of color females of childbearing age in comparison to age-, gender-, and skin phenotype-matched healthy females, even with the relatively higher cumulative doses (mean ± SD was 55 ± 79 J/cm2) that have been shown to reduce serum folate level in lighter skin phenotypes.

UNASSIGNED: There is still an unsatisfied need for new treatments for vitiligo with more rapid onset and long-term sustainability of repigmentation.
UNASSIGNED: We sought to evaluate the possible efficacy of heterologous type I collagen as an add-on therapy to narrowband ultraviolet B (NB-UVB) for the treatment of vitiligo.
UNASSIGNED: Five patients with non-segmental vitiligo older than 18 years with bilateral and approximately symmetrical vitiligo lesions that did not evolve in size for at least six months were included. All vitiligo lesions were treated with NB-UVB therapy according to the Vitiligo Working Group recommendations. Two selected nonfacial lesions of each patient were also treated with intradermal injections of heterologous type I collagen (HTIC) every two weeks. Repigmentation of HTIC plus NB-UVB-treated lesions and their symmetrical counterparts treated just with NB-UVB was evaluated at baseline and Week 12.
UNASSIGNED: Repigmentation of the HTIC-injected lesions started after the first treatment session in three cases and after the second session in two cases. After six sessions (Week 12), the mean repigmentation rate was 70.5 percent (95% confidence interval:0.569-0.841) in the NB-UVB plus HTIC treatment group versus 16.5 percent (95% confidence interval: 0.137-0.192) in NB-UVB treatment group (p=0.0006, paired t-test).
UNASSIGNED: Although the number of patients treated with the combination treatment was limited in our study, our results suggest that the addition of HTIC to NB-UVB therapy might offer a more rapid onset of repigmentation in patients with vitiligo.

BACKGROUND: Treatment of vitiligo has several challenges. Phototherapy and topical calcipotriol have been reported to be effective in combination with other therapies, but there is no consensus on the combination use.
OBJECTIVE: To perform a systematic review and meta-analysis that elucidates the efficacy of the combination of phototherapy and topical calcipotriol.
METHODS: This systematic review was performed by searching PubMed, EMBASE, Web of Science, Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), WanFang and VIP databases for relevant publications till February 28, 2021. Relative risk (RR) and its 95% confidence interval (CI) were used to evaluate the data. Bias assessment, heterogeneity and sensitivity analysis were conducted in this meta-analysis.
RESULTS: After screening, nine studies with 700 participants were included. The meta-analysis indicated that the combination of phototherapy and topical calcipotriol showed significantly higher effective rate (RR 1.11, 95% CI 1.02-1.22; p < 0.05) and apparent effective rate (RR 1.35, 95% CI 1.15-1.59; p < 0.01) than phototherapy monotherapy in the treatment of vitiligo. In addition, the side effects were minor, transient and tolerable.
CONCLUSIONS: This meta-analysis provides evidence supporting phototherapy combined with topical calcipotriol as a valuable treatment modality for patients with vitiligo, which has better efficacy than monotherapy.

BACKGROUND: Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial.
OBJECTIVE: To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy.
METHODS: A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports.
RESULTS: During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer.
CONCLUSIONS: Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races.
CONCLUSIONS: The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

OBJECTIVE: Prurigo nodularis is a chronic inflammatory skin disease characterized by highly pruritic nodular lesions that cause constant itching and scratching and significant quality-of-life impairment. It has been described in a range of conditions, including skin diseases (mainly atopic dermatitis) and metabolic, neurological, and psychiatric disorders. The pathophysiological mechanisms are largely unknown. Various modalities of phototherapy have been described as appropriate and safe treatments for achieving clinical control and alleviating symptoms. In this article, we describe our experience with phototherapy in patients with prurigo nodularis.
METHODS: Retrospective observational study of patients who received their first cycle of phototherapy to treat prurigo nodularis between March 2011 and October 2019. Information was collected on epidemiological and clinical characteristics, concomitant treatments, type and duration of phototherapy, maximum dose reached, and response to treatment.
RESULTS: We studied 44 patients (30 women and 14 men) with a median age of 65.5years. The most common form of phototherapy used was narrowband UV-B phototherapy (34 cycles, 77.27%) followed by a combination of UV-B and UV-A phototherapy (8 cycles). Response to treatment was considered satisfactory (clearance rate of ≥75%) in 24 patients (55.4%).
CONCLUSIONS: Phototherapy is a suitable treatment for prurigo nodularis in a considerable proportion of patients. It can be used as monotherapy or combined with other treatments.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) phototherapy has become a widely used, standard treatment modality in dermatology. The effect of 8-methoxypsoralen plus ultraviolet A on antinuclear antibody (ANA) formation has been investigated extensively, but there are very scarce data about the potential risk of NB-UVB phototherapy inducing production of ANAs. The aims of this study were evaluation of ANA status before and after NB-UVB treatment and comparison of ANA status with the healthy control group.
METHODS: Phototherapy unit database was used to identify patients who had received whole body NB-UVB treatment. Analyses of ANA were performed twice in the study group that were before initiation of the NB-UVB phototherapy and after cessation of the therapy. Also, ANAs were screened in the control group.
RESULTS: A total of 95 patients (50 males and 45 females; mean age: 43.03 ± 13.40) treated with NB-UVB radiation and 90 age- and sex-matched controls were included in the study. Thirteen patients (13.7%) were found to develop ANAs at the end of the treatment. ANA positivity was significantly more common in patients after phototherapy than in patients before phototherapy and than in the control group. None of the patients in the positive ANA group was diagnosed with any connective tissue diseases.
CONCLUSIONS: This study revealed that ANA positivity increased after NB-UVB phototherapy. However, it did not provide evidence for increased connective tissue disease risk. Therefore, ANA might not need to be routinely checked before treatment unless the patients have signs and symptoms indicating autoimmune diseases.

We report a case of a 13-year-old boy with extensive lymphomatoid papulosis (LyP) involving his elbows, forearms, proximal thighs, and right hip, with treatment-resistant nodules on his right forearm. He was treated with full-body narrowband ultraviolet B and targeted photodynamic therapy (PDT) with 20% aminolevulinic acid (ALA). After two months, there was complete resolution of the right forearm nodules. Due to its minimal toxicity, PDT offers unique advantages and may be considered for pediatric LyP patients with symptomatic, localized disease resistant to conventional treatments.

Phototherapy is a safe and effective treatment for many dermatologic conditions. With the advent of novel biologics and small molecule inhibitors, it is important to critically evaluate the role of phototherapy in dermatology. Surveys have shown that many dermatology residency programs do not dedicate time to teaching residents how to prescribe or administer phototherapy. Limitations of phototherapy include access to a center, time required for treatments, and insurance approval. Home phototherapy, a viable option, is also underused. However, it should be emphasized that modern phototherapy has been in use for over 40 years, has an excellent safety profile, and does not require laboratory monitoring. It can be safely combined with many other treatment modalities, including biologics and small molecule inhibitors. In addition, phototherapy costs significantly less than these novel agents. Dermatologists are the only group of physicians who have the expertise and proper training to deliver this treatment modality to our patients. Therefore, to continue to deliver high-quality, cost-effective care, it is imperative that phototherapy be maintained as an integral part of the dermatology treatment armamentarium.